Re: trabalhos interessantes VIII
From: Jaime (jaimen@zaz.com.br)
Tue, 13 Mar 2001 00:43:27 -0300
>----- Original Message -----
From: João Batista Marinho de Castro Lima <jbmclima@uol.com.br>
To: Multiple recipients of list OBSTET-L <obstet-l@mail.medispecialty.com>
Sent: Sunday, March 11, 2001 5:30 PM
Subject: Re: trabalhos interessantes VIII
Olá Thomaz, envie por favor para mim o trabalho.
Grato
Jaime Nonato de Oliveira
Av. Duque de Caxias, 669
CEP: 666090-250 - Marco
Belém- Pará
>> ----- Original Message -----
> From: "Thomaz Rafael Gollop" <trgollop@usp.br>
> To: "Multiple recipients of list OBSTET-L"
<obstet-l@mail.medispecialty.com>
> Sent: Sunday, March 11, 2001 7:13 AM
> Subject: Re: trabalhos interessantes VIII
>
> > Pois leiam o trabalho de Greggory DeVore(Pasadena, California) no
Prenatal
> > Diagnosis de Janeiro de 2001: The Genetic Sonogram.Entre outras coisas
ele
> chega
> > a conclusão, isto nos Estados Unidos, que a triagem de anomalias
> cromossomicas
> > por ultra-sonografia é mais eficiente do que o teste triplo.
> > Quem quiser xerox é só pedir e mandar endereço com CEP.
> >
> > Prof. Thomaz Gollop
> >
> > Jaime wrote:
> >
> > > Aos colegas da lista
> > >
> > > Ultrasom para rastrear sindrome de Down é um método bastante pobre.
> > >
> > > Publicação em 28/02/2001 The Journal of the American Medical
> Association
> > > (JAMA)
> > >
> > > A Dra. Rebecca Smith e o Dr. Bindman, da Universidade da Califórnia,
em
> São
> > > Francisco e seu grupo, realizaram uma meta análise de 56 estudos que
> > > avaliaram a ultrasonografia de segundo trimestre como método
rastreador
> da
> > > sindrome de Down.
> > > Os trabalhos escritos encontraram 130.365 fetos saudáveis que tinham
> falso
> > > positivo para a sindrome cromossomial, contra 1.930 fetos realmente
com
> a
> > > sindrome de Down
> > >
> > > Todos os estudos selecionaram mulheres com risco de gerar fetos com
> > > anomalias cromossomiais.
> > >
> > > Os marcadores ultrassonográficos usados, foram a prega nucal e o
cisto
> de
> > > plexo coroide, aquela mais confiável que este. Calcularam 79 falso
> > > positivos para a prega nucal e 611 para o cisto de plexo coróide para
> cada
> > > caso de Down detectado.
> > >
> > > O problema é que cada caso suspeito invariavelmente parte para
> métodos
> > > invasivos e aí temos mais perdas de fetos saudáveis pelas
complicações
> dos
> > > métodos invasivos do que diagnósticos de Down.
> > > Além disso a ansiedade imposta ao casal é imensurável, causando
muito
> > > sofrimento até o nascimento do bebê.
> > >
> > > Mais detalhes
> > >
> > > Second-Trimester Ultrasonography Impractical Screening Test for Down
> > > Syndrome
> > >
> > > WESTPORT, CT (Reuters Health) Feb 27 - Second-trimester
ultrasonography
> is a
> > > poor method of detecting fetuses with Down syndrome, resulting in more
> fetal
> > > losses than cases of the syndrome detected, according to a recently
> > > conducted meta-analysis of published studies.
> > >
> > > Dr. Rebecca Smith-Bindman, of the University of California, in San
> > > Francisco, and associates included in their analysis 56 studies that
> > > recorded second-trimester prenatal ultrasonographic markers reportedly
> > > associated with chromosomal abnormalities and outcome information. The
> > > articles described findings for 130,365 unaffected fetuses and 1930
> fetuses
> > > with Down syndrome.
> > >
> > > The sensitivity for Down syndrome was low, though the specificity for
> each
> > > marker was >95%, the investigators report in The Journal of the
American
> > > Medical Association for February 28. The most accurate marker for
> > > discriminating between unaffected and affected fetuses was a thickened
> > > nuchal fold, but even this marker had a low sensitivity.
> > >
> > > The investigators calculated that between 4454 and 87,413 women at
> average
> > > risk of having an affected fetus would need to be screened to detect
one
> > > case of Down syndrome. False positives would range from 79 for nuchal
> fold
> > > to 611 for choroid plexus cysts for each case of Down syndrome
detected.
> > >
> > > Dr. Smith-Bindman's team writes, "The use of the ultrasonographic
> markers as
> > > an indicator for invasive testing with amniocentesis will lead to an
> > > increase in the number of unaffected fetuses lost as a complication of
> the
> > > procedure."
> > >
> > > On the other hand, the investigators note, if women considered to be
at
> risk
> > > on the basis of maternal age or serum testing results forego
> amniocentesis
> > > due to the absence of ultrasonographic markers, the prenatal detection
> of
> > > Down syndrome will actually be reduced.
> > >
> > > "Most physicians who I speak with don't really like using these
> markers,"
> > > Dr. Smith-Bindman told Reuters Health. "They don't believe they're
> helpful
> > > in identifying babies truly affected by Down syndrome. But in this
> > > medical-legal environment, they feel that once they've seen it they're
> > > compelled to explain it to the woman and therefore recommend invasive
> > > testing."
> > >
> > > This causes a huge amount of anxiety for women, Dr. Smith-Bindman
noted.
> > > "Unfortunately, even when a second ultrasound or amniocentesis shows
the
> > > baby is normal, women remain stressed about it until the end of
> pregnancy,"
> > > she said. "Women are concerned if they've been told, for example, that
> their
> > > baby had a cyst in the brain."
> > >
> > > JAMA 2001;285:1044-1055.
> > >
> > > Jaime Nonato http://www.jaimenonato.com jaimen@zaz.com.br
> > >
> >
>
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